Abstract

Background Support for the adverse effect of high income inequality on population health has come from studies that focus on larger
areas, such as the US states, while studies at smaller geographical areas (eg, neighbourhoods) have found mixed results.

Methods We used propensity score matching to examine the relationship between income inequality and mortality rates across 96 neighbourhoods
(distritos) of the municipality of São Paulo, Brazil.

Conclusion In São Paulo, the more egalitarian communities are among some of the poorest, with the worst health profiles. Propensity
score matching was used to avoid inappropriate comparisons between the health status of unequal (but wealthy) neighbourhoods
versus equal (but poor) neighbourhoods. Our methods suggest that, with proper accounting of heterogeneity between areas, income
inequality is associated with worse population health in São Paulo.